Tramadol encapsulated into polyhydroxybutyrate microspheres: in vitro release and epidural analgesic effect in rats

BACKGROUND

Controlled release techniques are used to increase the duration of action and decrease the toxicity of drugs. Any controlled release form of tramadol in spinal or epidural blocks has not been studied previously. Tramadol was encapsulated into polyhydroxybutyrate (PHB) microspheres and release kinetics was studied. The epidural analgesic effect of this solution in rats was also compared with free tramadol.

METHODS

Controlled release of tramadol from PHB microspheres into 10 ml of phosphate buffer solution at pH 7.4 and 37 degrees C was studied in vitro. In vivo studies were performed in 40 rats. Epidural catheters were placed during general anaesthesia. Rats were randomly allocated into one of the four study groups to receive normal saline, 4 mg of tramadol, PHB microspheres without tramadol, or 4 mg of tramadol encapsulated into PHB microspheres. Analgesia was evaluated with tail flick tests performed at 52.5 +/- 0.5 degrees C before injection and at intervals up to 30 h after injection. Catalepsy and loss of corneal reflexes were considered as signs of supraspinal toxicity.

RESULTS

In vitro drug release was observed for more than 6 days. Epidural analgesic effects of tramadol released from PHB microspheres were observed for 21 h, whereas an equal dose of free tramadol was effective for less than 5 h. No signs of toxicity were observed.

CONCLUSION

Controlled release of tramadol from PHB microspheres is possible, and pain relief during epidural analgesia is prolonged by this drug formulation compared with free tramadol.

The effect of inflammation on rat urinary bladder-dependent relaxation in coaxial bioassay system

The effect of urinary bladder inflammation on the activity of a bladder-derived relaxant factor in the coaxial bioassay system was examined. Bladder inflammation was induced by intraperitoneal (i.p.) cyclophosphamide or intravesical lipopolysaccharide (LPS) injection to male rats. In precontracted rat anococcygeus muscle that was placed within rat bladder (coaxial bioassay system), acetylcholine induced a relaxation response, which was not altered by the denudation of urothelium or incubation with indomethacin and N(G)-methyl-L-arginine. Acetylcholine-induced relaxation was significantly attenuated, when bladders were removed from cyclophosphamide- and LPS-pretreated group of rats and were used with intact urothelium in the coaxial bioassay system. However, the impairment acetylcholine response in both pretreatment groups was not observed after denudation of the bladder urothelium. These results showed that bladder inflammation did not alter the synthesis and/or release of this bladder-derived relaxant factor, which is neither a cyclooxygenase product nor nitric oxide, but restricted its demonstration by coaxial bioassay assembly probably due to inflammation-induced mucosal oedema.

Anesthetic management of a patient with Weill-Marchesani syndrome

Weill-Marchesani syndrome is characterized by short stature, brachydactylyl, myopia, microspherophakia, lens dislocation, glaucoma, joint stiffness, restricted articular movements and facial features. The anesthetic management of an 11-year-old-male patient with diagnosis of this syndrome is reported.

Bernard-Soulier syndrome in a Turkish family

This report describes the first Turkish family to be diagnosed with Bernard-Soulier syndrome. The family consists of nine members (two parents, three sons and four daughters). The parents were first cousins. The index case, a 22 year-old-man, had a history of haemorrhagic diathesis with thrombocytopenia, giant platelets in the peripheral blood smear and a prolonged bleeding time. Refractory idiopathic thrombocytopenic purpura had been diagnosed elsewhere and a splenectomy had been performed six months previously. Ristocetin agglutination of platelets was defective and flow cytometry analysis of platelet membrane glycoprotein showed markedly reduced expression of glycoprotein lb (2.1%). Bernard-Soulier syndrome was diagnosed. Increased mean platelet volume was found in both parents, one son and three daughters. The other son and daughter were normal.

Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis

Clinical diagnosis of appendicitis is usually made on the basis of history, physical examination and laboratory studies. Approximately 30-45% of patients with suspected appendicitis present with atypical clinical and laboratory findings. Recently graded compression ultrasound and thin section unenhanced helical CT have been used to establish diagnosis for patients with suspected acute appendicitis. The purpose of this study was to determine the diagnostic accuracy of thin section unenhanced helical CT protocol in adult patients with suspected acute appendicitis. CT scans obtained when patients presented with right lower quadrant pain and the clinical impression was equivocal for appendicitis were evaluated. Of 296 patients referred for CT, 123 patients subsequently underwent surgery. Appendicitis had been correctly predicted in 104 of 108 patients surgically proven to have appendicitis. Unenhanced helical CT in the diagnosis of acute appendicitis had a sensitivity of 96%, specificity of 98%, positive predictive value of 97% and negative predictive value of 98%. If no definite inflammatory changes are detected, on the basis of our experience we recommend that the patient be monitored clinically, and that thin section unenhanced helical CT is the optimal technique to detect acute appendicitis in adult patients.

Effect of amino acid solutions on intraoperative hypothermia and postoperative shivering. Comparison of two anesthetic regimens

BACKGROUND

Intraoperative hypothermia is a major adverse effect of general anesthesia. The different anesthetics may influence thermoregulation differently. Proteins or amino acids have been postulated to stimulate heat production. The purpose of this study is to compare the effects of intraoperative administration of amino acid solutions on intraoperative hypothermia and postoperative shivering in two different anesthetic regimens.

METHODS

Forty ASA I-III craniotomy patients were assigned to four groups of 10 patients in a randomized prospective study, as follows: ISO - isoflurane-based anesthesia; PRO - propofol-based anesthesia; ISO + AA - Isoflurane-based anesthesia with supplementation of amino acid infusion; PRO + AA - Isoflurane-based anesthesia with supplementation of amino acid infusion. Hemodynamic parameters, esophageal temperature and postoperative shivering scores were recorded.

RESULTS

Core temperatures were higher during emergence in amino acid-treated propofol group, compared with the other groups. The core temperature decreased significantly in three groups throughout the operation, except the in amino acid-treated propofol group. The shivering intensity was less in the amino acid-treated groups.

CONCLUSION

The anesthetic method may influence the thermic effect of amino acids under general anesthesia. Propofol anesthesia has more thermogenic effect than isoflurane when combined with amino acid solutions.

Molecular cloning and characterization of PELP1, a novel human coregulator of estrogen receptor alpha

Nuclear hormone receptors (NRs) are transcription factors whose activity is regulated by ligands and by coactivators or corepressors. We report the characterization of a new NR coregulator: proline-, glutamic acid-, leucine-rich protein 1 (PELP1), a novel human protein that comprises 1,282 amino acids and is localized on chromosome 17. The primary structure of PELP1 consists of several motifs present in most transcriptional regulators including nine NR-interacting boxes (LXXLL motifs), a zinc finger, and glutamic acid- and proline-rich regions. We demonstrate that PELP1 is a coactivator of estrogen receptor alpha (ERalpha). PELP1 enhances 17beta-estradiol-dependent transcriptional activation from the estrogen response element in a dose-dependent manner. PELP1 interacts with ERalpha and also with general transcriptional coactivators p300 and cAMP response element-binding protein-binding protein. PELP1 was differentially expressed in various human and murine tissues with the highest expression levels in the testes, mammary glands, and brain. We also provide evidence supporting the developmental regulation of PELP1 expression in murine mammary glands, the detectable expression of PELP1 in human mammary cancer cell lines, and the enhanced expression of PELP1 in human breast tumors. These findings suggest that PELP1 is a novel coregulator of ERalpha and may have a role in breast cancer tumorigenesis.

Repeated transurethral resection and intravesical BCG for extensive superficial bladder tumors

PURPOSE

We report our experience with repeat transurethral resection (TUR) in a group of patients with superficial bladder tumors in whom complete resection in one session was impossible because of the extensive tumor burden.

PATIENTS AND METHODS

Only the patients with such extensive (>10 g of resected tissue) tumors that we were unable to perform complete TUR initially were included in the present study. The patients underwent repeat TUR(s) 4 weeks after the previous one until complete resection of the tumor was achieved. After complete TUR, if the pathology examination confirmed superficial disease, the patients received intracavitery immunotherapy and were followed up thereafter. If pathology examination documented muscle-invasive disease, cystectomy was suggested.

RESULTS

Of the 43 patients undergoing repeat TUR, 15 needed a second and 5 needed a third session to achieve complete resection. Of the patients, 28 (65%) had stage T1 and 15 (35%) has stage Ta tumor. Eight patients (19%) otherwise regarded as having superficial tumor were found to have muscle-invasive disease following repeat TURs. The mean follow-up of the remaining 35 patients with superficial disease was 34 months (range 1-126 months). Four of the patients with superficial disease progressed to T2 tumor. However, 16 patients achieved a state of complete response with no tumor recurrences during a mean of 38 months (range 4-126 month). The present protocol achieved bladder sparing in a total of 22 (63%) of the 35 patients with superficial disease.

CONCLUSIONS

From the presented series, we suggest that one can use the combination of repeat TUR and intravesical immunotherapy in the management of bulky superficial bladder tumors in an effort to preserve the bladder.

Percutaneous nephrostomy in the management of malignant ureteral obstruction secondary to bladder cancer

BACKGROUND AND PURPOSE

Malignant ureteral obstruction (MUO) is a common late manifestation of metastatic bladder cancer. We investigated the effectiveness of percutaneous nephrostomy (PN) in our patients with MUO associated with bladder cancer as judged by the serum creatinine concentration in the presence of unilateral or bilateral obstruction and in relation to the treatment results.

PATIENTS AND METHODS

The records of 23 consecutive patients with a mean age of 55 years (21 men, 2 women) who underwent PN were retrospectively reviewed. Eleven had unilateral obstruction. We assessed normalization of creatinine concentration, survival, and quality of life after PN in patients with either unilateral or bilateral obstruction.

RESULTS

The mean serum creatinine concentration before PN was 6 mg/dL (range 2.1-24.6 mg/dL). Percutaneous nephrostomy provided improvement to normal renal function in 19 patients (83%). The mean survival of patients after PN was 4.9 months (range 1-14 months). No independent factor playing a significant prognostic role was determined. The overall complication rate was 30% (7/23), namely kinking or dislodgment of nephrostomy tubes. After PN, all patients were able to undergo treatment for bladder cancer.

CONCLUSIONS

Percutaneous nephrostomy, with a low morbidity rate, is a safe urinary diversion technique in bladder cancer-induced MUO. It relieves at least the devastating effects of uremia and allows appropriate treatment for the malignancy.

Experience of 10 years with Churg-Strauss syndrome: An accompaniment to or a transition from aspirin-induced asthma?

Churg-Strauss syndrome is a rare, idiopathic, eosinophilic vasculitis appearing in concurrence with asthma which is often severe. Aspirin-induced asthma is a special clinical syndrome existing in nearly 10 % of adult asthmatics. After leukotriene antagonists had been marketed there has been marked increase in Churg-Strauss syndrome reports among the patients who had been followed up with asthma. This syndrome seems to be more frequent among the patients with aspirin-induced asthma. The role of leukotriene antagonists on the conversion from aspirin-induced asthma to Churg-Strauss syndrome has aroused attention and been questioned. Here we report 7 cases of Churg-Strauss syndrome where three had aspirin induced asthma which we have diagnosed in the last 10 years and where only one of them seems to be related to antileukotriene drug use.

Oxidative DNA damage and 8-hydroxy-2-deoxyguanosine DNA glycosylase/apurinic lyase in human breast cancer

To test the hypothesis that oxidative stress is involved in breast cancer, we compared the levels of 8-hydroxy-2-deoxyguanosine (8-oxo-dG), an oxidized DNA base common in cells undergoing oxidative stress, in normal breast tissues from women with or without breast cancer. We found that breast cancer patients (N = 76) had a significantly higher level of 8-oxo-dG than control subjects (N = 49). The mean ( +/- SD) values of 8-oxo-dG/10(5) dG, as measured by high-performance liquid chromatography electrochemical detection, were 10.7 +/- 15.5 and 6.3 +/- 6.8 for cases and controls, respectively (P = 0.035). This difference also was found by immunohistochemistry with double-fluorescence labeling and laser-scanning cytometry. The average ratios (x10(6)) of the signal intensity of antibody staining to that of DNA content were 3.9 +/- 7.2 and 1.1 +/- 1.4 for cases (N = 57) and controls (N = 34), respectively (P = 0.008). There was no correlation between the ages of the study subjects and the levels of 8-oxo-dG. Cases also had a significantly higher level of 8-hydroxy-2-deoxyguanosine DNA glycosylase/apurinic lyase (hOGG1) protein expression in normal breast tissues than controls (P = 0.008). There was no significant correlation between hOGG1 expression and 8-oxo-dG. Polymorphism of the hOGG1 gene was very rare in this study population. The previously reported exon 1 polymorphism and two novel mutations of the hOGG1 gene were found in three of 168 cases and two of 55 controls. In conclusion, normal breast tissues from cancer patients had a significantly higher level of oxidative DNA damage. The elevated level of 8-oxo-dG in cancer patients was not related to age or to deficiency of the hOGG1 repair gene.

Hypermethylation leads to silencing of the SYK gene in human breast cancer

A number of cancer-associated genes have been shown to be inactivated by hypermethylation of CpG islands during breast tumorigenesis. SYK, a candidate tumor suppressor, has been found not expressed in a subset of breast cancer cell lines, but the mechanism by which SYK is silenced is unclear. In this study, we examined the 5' CpG island methylation status of the SYK gene in breast cancer cell lines and primary breast cancer tissues. We found SYK 5' CpG hypermethylation in 30% (6/20) of breast cancer cell lines, and the aberrant methylation status was strongly associated with loss of SYK gene expression. Treatment of cells with a methylation inhibitor, 5-aza-2'-deoxycytidine, led to a reactivation of SYK expression in SYK-negative cells, as detected by reverse transcription-PCR. Using methylation-specific PCR, we demonstrated that SYK is hypermethylated in 32% (12/37) of unselected breast tumors, whereas all of the matched neighboring normal breast tissues exhibited unmethylated DNA status. We concluded that SYK is frequently inactivated through an epigenetic pathway in breast cancer. Because SYK has been shown to function as a tumor suppressor, and its loss of expression in breast cancer has been correlated with tumor invasiveness, the aberrant SYK methylation is responsible for the loss of expression and may consequently play a permissive role for tumor aggressiveness.

Multiple spinal intramedullary cavernous angioma: case report

Spinal cavernous angiomas frequently accompany to cranial cavernous angiomas. Multiple spinal cord cavernous angiomas are very rare and to authors knowledge, only one case has been described having multiple intramedullary cavernous angiomas without cranial involvement until now. In this report, we present a case with acute paraplegia who had thoracic and cervical intramedullary cavernous angiomas and normal cranial magnetic resonance imaging.

CYSTINE CALCULI IN CHILDREN: THE RESULTS OF A METABOLIC EVALUATION AND RESPONSE TO MEDICAL THERAPY

PURPOSE

We describe baseline metabolic abnormalities and evaluate mercaptopropionylglycine plus potassium citrate treatment for urinary abnormalities and to prevent new stone formation in children with cystine stones.

MATERIALS AND METHODS

Daily urinary excretions of calcium, oxalate, citrate, magnesium, urate and phosphorus were determined in 18 children with cystine stone and 24 healthy children. The cystine stone cases were treated with 10 to 15 mg./kg. alpha-mercaptopropionylglycine and 1 mEq./kg. potassium citrate daily for a median 15 months. The potassium citrate dose was adjusted to render urinary pH 6.5 to 7.5.

RESULTS

There was no significant difference in baseline metabolic profile between the cystine stone and control groups except for citrate. The cystine stone group excreted less citrate than the control group (p = 0.044). After treatment median plus or minus standard deviation urinary cystine 245 +/- 233 to 140 +/- 106 mmol./mol. creatinine decreased from (p = 0.015), and urinary citrate increased from 255 +/- 219 to 729 +/- 494 mg./1.73 m.2 (p = 0.003). No serious adverse reaction was noted. Of the 15 patients with followup data 5 (33%) had 8 recurrent calculi (recurrence rate 0.64 per patient year).

CONCLUSIONS

Our results suggest that further investigation of low citrate excretion is needed in cystinuric children. Potassium citrate therapy is effective in increasing urinary pH and urinary citrate. However, high recurrence rate and persistent cystinuria in our patients emphasize the inadequacy of our treatment schedule in the prevention of recurrent cystine calculi.

Percutaneous nephrolithotomy in patients aged 60 years or older

PURPOSE

To assess the safety and efficacy of percutaneous nephrolithotomy in patients more than 60 years old.

PATIENTS AND METHODS

We retrospectively evaluated and compared the data of 28 percutaneous nephrolithotomies (PCNL) performed on 27 patients aged 60 years and older (mean 65.8) with the data of the remaining 178 PCNL procedures on 166 patients performed in our clinic between December 1997 and December 1999.

RESULTS

Although staghorn stones seemed to be more common in the elderly group (25% v 22%), no statistical significance was demonstrated (P = 0.715), and the stone burden was similar for the two groups (P = 0.112). The only interesting finding in terms of patient characteristics was a significantly higher incidence of solitary kidney in patients aged 60 years or older (29% v 7%; P = 0.003). The success rates (stone-free patients and patients with residual stones <4 mm) were similar, being 89% for the elderly group and 92% for the younger patients (P = 0.718). Transfusion rates were also similar (21.4% in the elderly v 18% in the younger group; P = 0.662). No significant complication was observed in this elderly group, and no renal deterioration has been detected even in the follow-up of patients with a solitary kidney.

CONCLUSIONS

Despite the somewhat higher stone burden in the elderly patients (1077.92 mm2 v 920.85 mm2), the stone-free rate was similar to that obtained in the younger patients, without any higher rates of complications or blood transfusions or longer hospital stay. Percutaneous nephrolithotomy is a safe and effective method of stone treatment in the elderly, even if they have a solitary kidney or complex calculi.

Transport of Acids through Polyether-Sulfone Anion-Exchange Membrane

Diffusion dialysis of sulfuric acid and hydrochloric acid into water with a polyether-sulfone anion-exchange membrane was studied. Transport of sulfuric acid and hydrochloric acid through the membrane has been quantified by diffusion coefficients and mass transfer coefficients. The mass transfer coefficients were investigated as a function of the rotational speed of the stirring rate of both sides of the membrane and with different pH ranges. It was observed that the diffusion dialysis seems to be dependent on the rotational speed of the stirrer; in contrast, the membrane mass transfer coefficients are independent of rotational speed, but they are slightly affected by the initial acid concentration in donor phase. Copyright 2001 Academic Press.

Quantitative nuclear morphometry by image analysis for prediction of recurrence of ductal carcinoma in situ of the breast

Clinical management of ductal carcinoma in situ (DCIS) remains a challenge because significant proportions of patients experience recurrence after conservative surgical treatment. Unfortunately, it is difficult to prospectively identify, using objective criteria, patients who are at high risk of recurrence and might benefit from additional treatment. We conducted a multi-institutional, collaborative case-control study to identify nuclear morphometric features that would be useful for identifying women with DCIS at the highest risk of recurrence. Tissue sections of archival breast tissue of 29 women with recurrent and 73 matched women with nonrecurrent DCIS were stained for DNA, and nuclei in the DCIS lesions were evaluated by image analysis. A clear correlation between mean fractal2_area (FA2) and nuclear grade was observed (P < 0.001), allowing an objective determination of nuclear grade. Several nuclear morphometric features, including mean and variance of variation of radius, mean area, mean and variance of frequency of high boundary harmonics (FQH), and variance in sphericity, were found to be useful in discriminating recurrent from nonrecurrent DCIS subjects. However, the nuclear features associated with recurrence differed between high- and low-grade lesions. For lesions with high FA2 (nuclear grade 3), mean variation of radius, mean FQH, and mean area alone yielded recurrence odds ratios of 4.55 [95% confidence interval (CI) 0.45-45.96], 3.86 (95% CI, 0.88-16.98), 2.90 (95% CI, 0.31-27.2), respectively. Using a summed feature model, high-FA2 lesions showing three poor prognostic features had an odds ratio of 15.63 (95% CI, 1.22-200), compared with those with zero or one poor prognostic feature. Lesions with low mean FA2 (nuclear grade 1 or 2) showing high variances in sphericity and FQH had an odds ratio of 7.71 (95% CI, 1.77-33.60). Addition of other features did not enhance the odds ratio or its significance. These results suggest that nuclear image analysis of DCIS lesions may provide an adjunctive tool to conventional pathological analysis, both for the objective assessment of nuclear grade and for the identification of features that predict patient outcome.

Correlation of p27 protein expression with HER-2/neu expression in breast cancer

Strong expression of human epidermal growth factor receptor 2 (HER-2)/neu in breast cancer has been associated with poor prognosis. Reduced expression of p27(Kip1), a cyclin-dependent kinase inhibitor, correlates with poor clinical outcome in breast cancer. In this study, we provide a correlation between these two important prognostic markers in patients with breast cancer. Breast tumor screening using immunohistochemistry indicated that downregulation of p27 correlated with HER-2/neu overexpression in studying 11 normal breast tissues and 51 primary breast carcinomas. We found HER-2/neu protein overexpression in 20 (41%) of 49 breast cancers and low p27 protein expression in 47 (92%) of 51 breast cancers. All 20 (100%) of the tumors that overexpressed HER-2/neu had low levels of p27 protein product; this correlation was statistically significant (P = 0.035). Decreasing p27 expression correlated with increasing HER-2/neu activity. Our results suggest that one function of the HER-2/neu product is to downregulate p27 expression in breast cancer. This study may be significant in selecting patients for HER-2/neu antibody therapy in the future. Mol. Carcinog. 30:169--175, 2001.

Diagnostic value of interleukin-6 and C-reactive protein in acute appendicitis

The aim of this study is prospectively to evaluate the serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels in detection of acute appendicitis in patients with right iliac fossa pain. Data were collected in prospective manner on 102 consecutive patients with right iliac fossa pain. Laparotomy was performed for suspected acute appendicitis for 55 of the 102 patients, of whom 49 patients had appendicitis, 6 patients non-appendicitis (NA), and the other 47 patients had nonspecific abdominal pain (NSAP) and they did not undergo operation. Among those with appendicitis 31 had acute appendix (AA), 8 had gangrenous appendix (GA), and 10 had perforated appendix (PA). The WBC and CRP the mean (SEM) values were significantly different in AA, GA, and PA groups compared with NSAP and NA groups (P < 0.05). Although the mean IL-6 levels were significantly different only in PA group than the others groups (P < 0.05). The sensitivity and specificity of serum CRP measurements were calculated as 96% and 87%, respectively whereas these were 33% and 83% for IL-6 levels for the diagnosis of the acute appendicitis. As a result, measurement of the CRP levels and WBC have an additional diagnostic value on the diagnosis of the acute appendicitis but determination of IL-6 levels which added to the test combination of WBC and CRP, the sensitivity for the diagnosis of the acute appendicitis was not changed whereas the specificity was decreased to 66%.

Comparison of BTA stat and NMP22 tests in the detection of bladder cancer

OBJECTIVE

This study aimed to compare the BTA (bladder tumour antigen) stat and urinary nuclear matrix protein (NMP22) tests in the detection of bladder cancer.

MATERIAL AND METHODS

The office-based qualitative BTA stat and the laboratory-based quantitative NMP22 tests were studied in the same urine samples obtained from 49 patients with a high suspicion of bladder cancer and 20 healthy subjects.

RESULTS

A tumour was identified in 36 patients after the cystoscopy. BTA stat demonstrated a sensitivity of 89%, which was superior to the sensitivity of 66.6% with the NMP22 test in detecting the bladder cancer (p < 0.02). The sensitivities for grade I tumours with BTA stat and NMP22 were 55.5% and 33.3%, respectively. The sensitivity of BTA stat was 100% for tumour categories except for the pTa and grade I tumours. No positive result was observed with both tests among the healthy subjects. The specificities for BTA stat and NMP22 were 78.7% and 69.6%, respectively.

CONCLUSIONS

The BTA stat test was significantly more sensitive than the NMP22 test in the detection of bladder cancer. Although the sensitivity of BTA stat was not sufficient to replace cystoscopy, its ease and low cost may play a role in reducing the number of control cystoscopies, especially in patients with low risk of progression.